Drug delivery to the cardiovascular system is approached at three
levels: (1) routes of drug delivery; (2) formulations; and finally (3)
applications to various diseases. Formulations for drug delivery to the
cardiovascular system range from controlled release preparations to
delivery of proteins and peptides. Cell and gene therapies, including
antisense and RNA interference, are described in full chapters as they
are the most innovative methods of delivery of therapeutics. Various
methods of improving systemic administration of drugs for cardiovascular
disorders are described including use of nanotechnology.

Cell-selective targeted drug delivery has emerged as one of the most
significant areas of biomedical engineering research, to optimize the
therapeutic efficacy of a drug by strictly localizing its
pharmacological activity to a pathophysiologically relevant tissue
system. These concepts have been applied to targeted drug delivery to
the cardiovascular system. Devices for drug delivery to the
cardiovascular system are also described.

Role of drug delivery in various cardiovascular disorders such as
myocardial ischemia, hypertension and hypercholesterolemia is discussed.
Cardioprotection is also discussed. Some of the preparations and
technologies are also applicable to peripheral arterial diseases.
Controlled release systems are based on chronopharmacology, which deals
with the effects of circadian biological rhythms on drug actions.A full
chapter is devoted to drug-eluting stents as treatment for restenosis
following stenting of coronary arteries.Fifteen companies are involved
in drug-eluting stents.

New cell-based therapeutic strategies are being developed in response to
the shortcomings of available treatments for heart disease. Potential
repair by cell grafting or mobilizing endogenous cells holds particular
attraction in heart disease, where the meager capacity for cardiomyocyte
proliferation likely contributes to the irreversibility of heart
failure. Cell therapy approaches include attempts to reinitiate
cardiomyocyte proliferation in the adult, conversion of fibroblasts to
contractile myocytes, conversion of bone marrow stem cells into
cardiomyocytes, and transplantation of myocytes or other cells into
injured myocardium.

Advances in molecular pathophysiology of cardiovascular diseases have
brought gene therapy within the realm of possibility as a novel approach
to treatment of these diseases. It is hoped that gene therapy will be
less expensive and affordable because the techniques involved are
simpler than those involved in cardiac bypass surgery, heart
transplantation and stent implantation. Gene therapy would be a more
physiologic approach to deliver vasoprotective molecules to the site of
vascular lesion. Gene therapy is not only a sophisticated method of drug
delivery; it may at time need drug delivery devices such as catheters
for transfer of genes to various parts of the cardiovascular system.

The cardiovascular drug delivery markets are estimated for the years
2017 to 2027 on the basis of epidemiology and total markets for
cardiovascular therapeutics. The estimates take into consideration the
anticipated advances and availability of various technologies,
particularly drug delivery devices in the future. Markets for
drug-eluting stents are calculated separately. Role of drug delivery in
developing cardiovascular markets is defined and unmet needs in
cardiovascular drug delivery technologies are identified.

Selected 82 companies that either develop technologies for drug delivery
to the cardiovascular system or products using these technologies are
profiled and 81 collaborations between companies are tabulated. The
bibliography includes 200 selected references from recent literature on
this topic. The report is supplemented with 31 tables and 9 figures